Otitis media and tonsils--role of adenoidectomy in the treatment of chronic otitis media with effusion.

Innate immunity involves the first line of the mucosal defense system. Homeostatic defense of the middle ear and Eustachian tube is maintained in part by molecules related to the innate immunity. The middle ear and tonsils are the organs related to the innate immunity. Recent attention has focused on the possibility that chronic otitis media and adenotonsillitis may represent a chronic infective state such as evidenced in conditions secondary to biofilms or small colony variants. The role of biofilms in the persistence of chronic mucosal-based ENT-related infections was first recognized in otitis media and adenotonsillitis. The efficacy of adenotonsillectomy on otitis media with effusion (OME) has been demonstrated by several randomized and controlled studies. It was speculated that tonsil and adenoid may play a role as an infectious focus to OME. In summary, patients suffering from recurrent or chronic OME may benefit from adenoidectomy due to the removal of an infectious source in the nasopharynx rather than the removal of a large adenoidal mass.